According to homehealthcahps.org, Development of the CAHPS report began in 1995 as part of the Consumer Assessment of Healthcare Providers and Systems Initiative. The Federal Government’s intention in creating the CAHPS reports was to increase the public’s ability to make informed choices about their healthcare and who provides this care, to promote high quality health care by providers, and to reward providers who reach the highest quality standards. Implementation of the CAHPS reporting began in 2002 in the Long-Term Care setting, and expanded to Home Health and Hospitals in 2003. Surveys began in 2009 with agencies participating on a voluntary basis, before the annual payment update began. CMS began publishing results of the HHCAHPS survey reports on their home health compare earlier this year, on April 19, 2012. [1]
Results of the HHCAHPS reports, posted on CMS’s Home Health Compare, are available for use by the general public and may be used in making decisions regarding which agency will provide their care. Results will also be used by CMS to award higher-performing agencies in the pay for performance environment.[2] Because of this, it is important that the agency do all within their power to understand and ensure that they are getting the best scores possible. A good understanding of the HHCAHPS questions, QA projects to monitor any issues related to the HHCAHPS reports, and staff education will aid your agency in achieving the best scores possible.
Knowing that Home Health Compare focuses on items regarding communication between the agency and the patient, professionalism of the agency and clinicians, and specific care items such as pain, medications and safety, agencies should focus their QA efforts on these items. However, ongoing staff training in all aspects of care will help ensure good marks on the survey questions that have patients rank the agency on a 1-10 scale and whether or not the patient would “definitely” recommend the agency to “friends and family”. The following items should be considered when thinking of increasing patient satisfaction and quality of health care.
1) Communication between the agency and the patient
From the time of referral until discharge, patients and family members should be informed about the care they will receive. When you receive a referral, call the patient or patient’s family. This contact will allow you to gather initial information, set up the admission visit and answer any questions the patient may have. On the admission visit, be sure you go over the patient’s rights and responsibilities, the services that will be provided, and how often they will be provided. This is a Medicare Condition of Participation and must be done for each patient[3]. Giving this information will also help put the patient at ease and let them participate in planning their care, which is also a Medicare requirement. As care continues, be sure you inform the patient or caregivers of any changes in treatment, frequencies, clinician assignments, or other changes that occur. This alone will increase patient satisfaction immensely.
2) Professionalism
Think of the last time you saw your physician, accountant, or minister. If they were not “dressed the part”, did you feel as comfortable as you did when you had similar encounters with persons who dressed professionally? Surveys have shown that seniors, as well as the general public, have an increased sense of trust in clinicians who dress like clinicians or follow a dress code. State Practice Acts often state that professionals must wear identification stating their name and title at all times in a practicing environment. This can be either agency-provided identification or generic name tags with name and credentials/title. Clinicians should follow agency policy, whether for scrubs or business casual wear, when making patient contact.
Clinicians should treat patients with dignity and respect at all times. Take the time to listen to your patient during your visit, rather than seeming “rushed”. Things that might seem small, such as calling a patient to remind them of an appointment time or notifying them when you are running late, validates the vulnerable home care patient and lets them know they are important to you. In addition, the establishment of professional boundaries with your patients, and use of simple but professional terms when teaching will give the patient reassurance that you know what you are knowledgeable and willing to help them meet their goals for health. This will also increase patient satisfaction.
3) Addressing Pain
Clinicians should address pain every visit and teach patients about pain control. Ask questions about the patient’s pain: where it is located, when it started or worsened, and when they last took a medication for this pain or performed another type of pain intervention. Call the physician with pain that is not well controlled. If you have ever been in pain, especially for more than a couple of days, you realize how important this is. Again, as a quality indicator, this amount of attention to our patients will show we care about them and will increase their satisfaction overall.
4) Medication Management
This is another big deal item for Medicare as well as patients. The HHCAHPS surveys directly asks patients if their home health providers asked to see patient’s prescription and over the counter medications, whether or not the provider talked about the purpose and side effects of medications, and when to take the medications. Make a point to let the patient know that you will be looking at their medications and ask them to have the medications ready when you arrive. Let the patient know that a list of medications is not sufficient as you need to view the bottles for start dates, fill dates, and expiration dates. This will help monitor compliance and safety. Also be sure you ask patients at every visit whether they have had new medications added or discontinued.
5) Home Safety
Another important measure for ensuring that patients are satisfied, as well as for keeping patients out of the hospital and on the road to recovery is safety teaching and assessments. It is therefore imperative that you conduct thorough safety assessments. When conducting the initial assessment, avoid answering MO questions as interview only questions. Have the patient walk you to his or her bathroom. See their environment and how safely they maneuver through it. Make recommendations right away for needed ADL equipment as well as smoke detectors, removal of throw rugs, or addition of lighting in low lighted areas. Obtain orders for social service intervention if your patient lacks resources to obtain needed items. Patients who avoid another hospital stay or fall are happy patients indeed. Decreasing the number of patients from your agency who have falls and ER trips or associated hospital stays also makes Medicare happy.
CMS recently published guidelines regarding rules for alerting patients about the HHCAHPS Survey. In these guidelines, they state that it is acceptable to inform patients that they may be asked to respond to a patient experience survey conducted by a government associated survey group. However,” it is not acceptable for a home health agency to give a copy of the HHCAHPS Survey questionnaire to the patients; contact patients to ask them if they want to participate in the survey; send letters or otherwise contact patients to advise them on how to respond to survey questions; or tell patients that the home health agency expects them to respond favorably or in a certain way to survey questions.”
HHCAHPS Protocols and Guidelines Manual, which is available on the HHCAHPS web site is the official manual for the HHCAHPS Survey. Failure to comply with the guidelines in this manual may put the agency at risk for not receiving the annual payment update.
Beginning this month, HHCAHPS Survey results will be posted based on the data collected between January 1, 2011 and December 31, 2011. This information will be updated quarterly, with the oldest quarterly information falling off as new information is updated. By preparing your staff and your agency, you will increase your satisfaction survey results and be ready for the pay for performance mandates when they are implemented.
NOTE According to homehealthcahps.org, results from the Home Health Care CAHPS (HHCAHPS) Survey will be “refreshed” on Home Health Compare on the www.medicare.gov on July 19, 2012. The results that will be published in July 2012 are based on data collected from patients who received skilled home health care at some point between January 1, 2011, and December 31, 2011. Preview reports for this update can be viewed currently on the HHCAHPS website using your agency’s information.
REFERENCES:
[1] www.homehealthcahps.org
[2] CMS/www.medicare.gov/homehealthcompare
[3] gpoaccess.gov, 42 CFR 484
